634 



PUNCTURE OF THE BLADDER. 



is here attended with difficulty. Hering, who recommends this 

 operation for dogs, places the animal on its side, and, after making 

 an incision through the skin, passes a thin trocar into " the tensest 

 portion of the swelling in the lower region of the flank." In man 

 the puncture is made close to the linea alba, and the same procedure 

 has been recommended in dogs. Hering states having completely 

 cured a dog by his method, though he does not say 

 what caused the difficulty in urination. 



(2) In large animals puncture is effected from the 

 rectum (punctio rectalis). 



This is the easiest method and that usually 

 followed when it is desired, as often happens in 

 oxen, promptly to remove the danger of ruptured 

 bladder, and it is intended to slaughter the animal 

 in a short time. The cannula, with the trocar drawn 

 back (covered) is introduced into the rectum, and 

 directed as nearly as possible perpendicularly to the 

 surface of the bladder. It is well not to go much 

 beyond the neck of the bladder, but rather to pierce 

 it close behind the neck, so as to avoid opening the 

 peritoneal sac. 



(3) Punctio perinealis deserves preference in large 

 animals unless when destined for early slaughter. 

 Inflammation of the urinary bladder is less likely 

 than in punctio rectalis, where it readily occurs in 

 consequence of infection from the rectum. The skin 

 is incised close below the anus and somewhat to the 

 side of the urethra, and efforts are made to penetrate 

 thence as far as the neck of the bladder by working 

 with the fingers, assisted when needful with knife and 

 scissors. As soon as the distended urinary bladder is 

 felt, a straight trocar with the point covered is intro- 

 duced, placed on the bladder and the stilette pressed 

 forwards. On withdrawal, urine is discharged through 

 the cannula, which is slowly thrust forward so as to 



follow the movement of the collapsing walls of the bladder. Should a 

 single evacuation suffice, the trocar is at once removed ; it is not 

 necessary to suture the skin wound. Hering recommends, after making 

 the cutaneous incision, to thrust the trocar directly forwards in the 

 direction of the urethra, as far as the bladder without dividing the 

 connective tissue. When considerably distended, the bladder can 

 scarcely be missed. Should the prostate or vesicular seminales be 



Fig. 436. 

 Flourant's trocar. 



